What is the initial treatment approach for a patient with a contusion?

Initial Treatment of Contusion

Apply ice (or ice-water mixture) to the contusion for 20 minutes at a time, using a barrier between the cold source and skin, combined with compression and elevation of the affected area. 1

Immediate First Aid Management

Cold Application (Primary Intervention)

• Use an ice-water mixture in a plastic bag or damp cloth rather than ice alone or gel packs, as this provides superior cooling effectiveness 1
• Apply cold for 20 minutes maximum per session; if uncomfortable, limit to 10 minutes 1
• Place a thin towel barrier between the cold container and skin to prevent cold injury 1, 2
• Cold application decreases hemorrhage, edema, pain, and disability in soft tissue injuries 1

Compression and Elevation

• Apply compression bandaging to the injured area, though evidence for joint injuries specifically is limited 1
• Elevate the injured extremity to reduce swelling 1
• Rest the affected area initially 3

Critical Pitfall to Avoid

• Do NOT apply heat to acute contusions—heat application is inferior to cold therapy for acute soft tissue injuries 1

Location-Specific Considerations

Muscle Contusions (Extremity)

• For thigh contusions specifically, place the knee in 120 degrees of flexion for the first 24 hours 4
• This early positioning is critical for optimal outcomes and preventing complications 4
• Follow with range-of-motion exercises and gradual activity advancement after 24 hours 4

Bladder Contusions

• Bladder contusions require no specific treatment and may be observed clinically 1
• These are self-limiting injuries that do not require intervention 1

Ureteral Contusions

• Ureteral contusions may require stenting if urine flow is impaired 1
• When identified during laparotomy, manage with ureteral stenting or resection with primary repair depending on viability 1
• Complications include delayed stricture or necrosis, particularly after gunshot wounds 1

Pulmonary Contusions

• These represent a distinct pathophysiological entity requiring specialized management beyond simple first aid 1, 5
• Associated with increased risk of respiratory failure, pneumonia, and ICU admission 1
• Require close monitoring and potential ventilatory support 1, 5

Medication Considerations

NSAIDs - Use With Caution

• Nonsteroidal anti-inflammatory drugs can be detrimental to healing if used for more than 48-72 hours 4
• Limit NSAID use to the acute phase only 4

Corticosteroids - Avoid

• Glucocorticosteroids should be avoided in muscle contusion treatment 4

Monitoring for Complications

Watch for Warning Signs

• Myositis ossificans (heterotopic bone formation) can develop after muscle contusions 4, 6
• Compartment syndrome is a potential complication requiring urgent recognition 4
• Progressive pain, persistent swelling, or functional deterioration warrant reassessment 4, 6

Evidence Quality Note

The RICE (Rest, Ice, Compression, Elevation) protocol is widely recommended but actual implementation in clinical practice is poor, with complete RICE treatment applied in only 3% of cases in one survey 3. Despite limited controlled clinical trials in humans, the recommendations are based on consistent guideline consensus from the American Heart Association and American Red Cross 1, supported by animal research demonstrating the natural healing process involving muscle repair, regeneration, and scar tissue formation 6.